Surveillance of high-risk individuals for pancreatic cancer with EUS and MRI: A meta-analysis

Kogekar, Nina; Diaz, Kelly E.; Weinberg, Alan; Lucas, Aimee L.

doi:10.1016/j.pan.2020.10.025

Cited by 21 publications

(18 citation statements)

References 39 publications

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“…In another review, the detection rate of high-grade precancerous lesions and invasive PDAC is reported to be 0.74% for high-risk individuals [20]. Additionally, another recent review reports that the detection rate of high-grade precancerous lesions and T1N0M0 PDAC is 0.9% for high-risk individuals [22]. However, the high-grade precancerous lesions reported in these reviews are mainly high-grade IPMNs, and only a few high-grade PanIN cases included.…”

Section: Challenges To Be Solved In Diagnosis Of High-grade Panin 61mentioning

confidence: 99%

See 1 more Smart Citation

Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

Sagami

Yamao

Nakahodo

et al. 2021

Cancers

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Pancreatic ductal adenocarcinoma (PDAC) arises from precursor lesions, such as pancreatic intra-epithelial neoplasia (PanIN) and intraductal papillary mucinous neoplasm (IPMN). The prognosis of high-grade precancerous lesions, including high-grade PanIN and high-grade IPMN, without invasive carcinoma is good, despite the overall poor prognosis of PDAC. High-grade PanIN, as a lesion preceding invasive PDAC, is therefore a primary target for intervention. However, detection of localized high-grade PanIN is difficult when using standard radiological approaches. Therefore, most studies of high-grade PanIN have been conducted using specimens that harbor invasive PDAC. Recently, imaging characteristics of high-grade PanIN have been revealed. Obstruction of the pancreatic duct due to high-grade PanIN may induce a loss of acinar cells replaced by fibrosis and lobular parenchymal atrophy. These changes and additional inflammation around the branch pancreatic ducts (BPDs) result in main pancreatic duct (MPD) stenosis, dilation, retention cysts (BPD dilation), focal pancreatic parenchymal atrophy, and/or hypoechoic changes around the MPD. These indirect imaging findings have become important clues for localized, high-grade PanIN detection. To obtain pre-operative histopathological confirmation of suspected cases, serial pancreatic-juice aspiration cytologic examination is effective. In this review, we outline current knowledge on imaging characteristics of high-grade PanIN.

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Section: Challenges To Be Solved In Diagnosis Of High-grade Panin 61mentioning

confidence: 99%

“…In clinical practice, high-grade PanIN is difficult to detect without an associated invasive PDAC. In addition, high-grade PanIN is also rarely found in large-scale screening studies of patients with a strongly related family history or with PDAC-associated gene mutations [20][21][22][23][24][25][26][27][28].…”

Section: Introductionmentioning

confidence: 99%

Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

Sagami

Yamao

Nakahodo

et al. 2021

Cancers

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“…However, imaging findings are only clarified when various imaging examinations are performed. In addition, only approximately 30% of early stage PDAC is undetectable as a tumor using various imaging modalities [ 4 , 13 , 14 , 15 ]. Therefore, indirect imaging findings, such as main pancreatic duct (MPD) dilation or pancreatic cysts, including intraductal mucinous cystic neoplasm (IPMN), are important diagnostic signs [ 13 , 14 , 16 , 17 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

“…In addition, only approximately 30% of early stage PDAC is undetectable as a tumor using various imaging modalities [ 4 , 13 , 14 , 15 ]. Therefore, indirect imaging findings, such as main pancreatic duct (MPD) dilation or pancreatic cysts, including intraductal mucinous cystic neoplasm (IPMN), are important diagnostic signs [ 13 , 14 , 16 , 17 , 18 ]. Realistically, examining all individuals for factors associated with PDAC in detail is difficult, and not all of them can be examined by imaging modalities.…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Strategy of Early Stage Pancreatic Cancer via Clinical Predictor Assessment: Clinical Indicators, Risk Factors and Imaging Findings

et al. 2022

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Early detection of pancreatic ductal adenocarcinoma (PDAC) in the general population is difficult due to unknown clinical characteristics. This study was conducted to clarify the factors associated with early stage PDAC. Well-known symptoms and factors associated with PDAC were classified into clinical indicators, risk factors, and imaging findings concomitant with early stage PDAC. To analyze these factors for the detection of patients with early stage PDAC compared to patients without PDAC, we constructed new diagnostic strategies. The factors of 35 patients with early stage PDAC (stage 0 and IA) and 801 patients without PDAC were compared retrospectively. Clinical indicators; presence and number of indicators, elevated pancreatic enzyme level, tumor biomarker level, acute pancreatitis history, risk factors; familial pancreatic cancer, diabetes mellitus, smoking history, imaging findings; presence and number of findings, and main pancreatic duct dilation were significant factors for early stage PDAC detection. A new screening strategy to select patients who should be examined by imaging modalities from evaluating clinical indicators and risk factors and approaching a definitive diagnosis by evaluating imaging findings had a relatively high sensitivity, specificity, and areas under the curve of 80.0%, 80.8%, and 0.80, respectively. Diagnosis based on the new category and strategy may be reasonable for early stage PDAC detection.

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“…This data highlights the compelling need to develop surveillance strategies to detect PDAC at early stages for those at increased risk including BRCA1, BRCA2, ATM, and PALB2 carriers (15). PDAC surveillance is generally performed through regular imaging of the pancreas with endoscopic ultrasound (EUS) or MRI, without definitive evidence showing one imaging modality is superior (16,17). Early surveillance results have been promising, with one large European study of high-risk individuals showing that among CDKN2A carriers with surveillance-detected PDAC, the resection rate was 75%, with a 5-year survival of 24% (18).…”

Section: Introductionmentioning

confidence: 99%

EUS-based Pancreatic Cancer Surveillance in BRCA1/BRCA2/PALB2/ATM Carriers Without a Family History of Pancreatic Cancer

Katona

Long

Ahmad

et al. 2021

Cancer Prevention Research

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Carriers of a pathogenic/likely pathogenic (P/LP) BRCA1/BRCA2/ATM/PALB2 variant are at increased risk of pancreatic ductal adenocarcinoma (PDAC), yet current guidelines recommend surveillance only for those with a family history of PDAC. We aimed to investigate outcomes of endoscopic ultrasound (EUS)–based PDAC surveillance in BRCA1/BRCA2/ATM/PALB2 carriers without a family history of PDAC. We performed a retrospective analysis of all P/LP BRCA1/BRCA2/ATM/PALB2 carriers who underwent EUS at a tertiary care center. Of 194 P/LP BRCA1/BRCA2/ATM/PALB2 carriers who underwent EUS, 64 (33%) had no family history of PDAC and had at least 1 EUS for PDAC surveillance. These individuals underwent 143 total EUSs, were predominantly female (72%), and BRCA2 carriers (73%), with the majority having a personal history of cancer other than PDAC (67%). The median age at time of first EUS was 62 years [interquartile range (IQR), 53–67 years] and a median of 2 EUSs (IQR 1–3) were performed per patient, with a median of 3 years (IQR 2–4.5 years) between the first and last EUS for those with more than 1 EUS. Pancreatic abnormalities were detected in 44%, including cysts in 27%, and incidental luminal abnormalities in 41%. Eight percent developed a new pancreatic mass or cyst during surveillance, 2 individuals developed PDAC, and no serious complications resulted from surveillance. After discussion of the risks, limitations, and potential benefits, PDAC surveillance can be considered in BRCA1/BRCA2/ATM/PALB2 carriers without a family history of PDAC; however, the effectiveness of PDAC surveillance in this population requires further study. Prevention Relevance: BRCA1/BRCA2/ATM/PALB2 carriers have increased pancreatic ductal adenocarcinoma (PDAC) risk, yet are typically not eligible for PDAC surveillance in the absence of PDAC family history. Herein we describe outcomes of PDAC surveillance in BRCA1/BRCA2/ATM/PALB2 carriers without a family history of PDAC, showing that PDAC surveillance can be considered in this high-risk group.

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Surveillance of high-risk individuals for pancreatic cancer with EUS and MRI: A meta-analysis

Cited by 21 publications

References 39 publications

Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

Pre-Operative Imaging and Pathological Diagnosis of Localized High-Grade Pancreatic Intra-Epithelial Neoplasia without Invasive Carcinoma

Diagnostic Strategy of Early Stage Pancreatic Cancer via Clinical Predictor Assessment: Clinical Indicators, Risk Factors and Imaging Findings

EUS-based Pancreatic Cancer Surveillance in BRCA1/BRCA2/PALB2/ATM Carriers Without a Family History of Pancreatic Cancer

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